New England Equine Medical & Surgical Center

15 Members Way · Dover NH 03820 · www.newenglandequine. com · 603.749.9111

 

Understanding Equine Cellulitis

By Lauren Hughes, DVM

Cellulitis can be a relatively common and frustrating condition affecting the limbs of horses.
The condition results from inflammation and infection of the subcutaneous tissues that lie
beneath the skin. It commonly affects only one limb at a time and is most likely in the hind end.

Clinical Signs
The typical presentation of cellulitis is very prominent swelling of a limb that is often associated
with lameness. The lameness is normally quite severe, with some horses even refusing to bear
weight on the limb, and owners notice that it develops quite rapidly. Either areas of the limb or
the entire limb will swell up and can reach 2-3x the normal size. The affected limb often
becomes very warm and painful to the touch, and pitting edema may be present. A fever may be
present and the horse may exhibit other signs of not feeling well including being lethargic and
off feed.

Fig 1. Cellulitis

Causes
Cellulitis cases can have no known trigger or may follow an insult including surgery, joint
injections, wounds or trauma. The most common bacteria to be isolated from these cases are
Staphylococcus spp. which normally inhabit the skin. These bacteria then can enter the deeper
tissues and lead to infection through some break in the skin barrier. Edema in these tissues then
forms when the bacteria and the toxins they release create an inflammatory response. This leads
to blood vessels and lymph vessels becoming leaky and tissue building up in the subcutaneous
tissue.

Diagnosing Cellulitis
It is very important to get your veterinarian involved when a case of cellulitis is suspected as
prompt diagnosis and treatment are crucial to successful recovery. Your veterinarian may
suspect cellulitis on physical examination when a horse has a swollen, warm, painful limb and is
exhibiting prominent lameness. It is important to rule out other causes of severe lameness and
limb swelling including joint infections and fractures as well. Supporting diagnostics are then
used to confirm and assess the extent of the condition. Ultrasound can be very useful in looking
 New England Equine Medical & Surgical Center
15 Members Way · Dover NH 03820 · www.newenglandequine. com · 603.749.9111
 

at the subcutaneous tissues and highlighting the presence of edema, seen as fluid accumulation
within the tissue layers. Bloodwork will often show an elevation in the fibrinogen level, a
marker used to assess inflammation, and/or changes to white blood cell counts.

Treatment
The main stays of cellulitis treatment focus on eliminating the infection from affected tissues and
supportive care to decrease the limb swelling. Broad spectrum antibiotics are commonly used to
help clear the infection. NSAIDs can also be used to help control any pain and inflammation.
Hydrotherapy with cold hosing, bandaging, sweat wraps and hand-walking or lunging are often
crucial components of treatment and are used in combination to help reduce the swelling of the
limb. Treatment can often be quite frustrating as many of these cases can take a while to resolve
and full resolution is not always achieved.

Complications
Prompt and thorough treatment is very important in these cases as devastating and life
threatening complications can follow a case of cellulitis. Some horses undergo very severe and
deep infections that cannot be corrected with medical management alone and surgical
debridement or drainage is necessary. In other cases, thrombosis of vessels can occur which
leads to necrosis of tissue and skin sloughing wounds. These wounds can involve important
underlying structures and may require a long and expensive period of intensive wound care and
bandaging to resolve. Lastly, laminitis can occur in the affected limb due to damage to the
coronary band or can develop in the contralateral limb due to the extra stress placed upon that
limb.

Prognosis
Although survival rates are quite high and treatment is often successful, prognosis for a full
recovery is not guaranteed. Some horses may have recurrence of the infection or suffer from
lameness when returning to normal work loads after the initial episode. Chronic cases will often
lead to a permanently thicker leg due to the presence of scar tissue. This can permanently affect
the horses’ ability to normally drain the lymphatic system. Client compliance and early
detection are crucial in recognizing chronic recurring cases and prompt treatment will help
prevent episodes from progressing. Horses that are prone to recurring episodes are often
maintained on strict exercise programs and extra care is taken to ensure proper hygiene and
prevent exposure to infections.

If you have any other questions regarding cellulitis, please feel free to contact New England
Equine Medical & Surgical Center.

Sources:
Barr, Bonnie. Cellulitis. Rood & Riddle. 2011.Webpage.
Fig 1: Cellulitis. Anoka Equine Veterinary Services. 4 August 2014. Webpage.
Getman, Liberty M. Alternative Therapies for Cellulitis. ACVS Proceedings. 2011. Print.
Holmes, Peter. Lymphangitis in Horses. Merck Veterinary Manual. 2011. Webpage.
Reed, Bayly and Sellon. Equine Internal Medicine- 3rd Edition. St. Louis: Elsevier, 2010. Print.